Health Disparities
Does Health Care Access Mediate the association between Material Deprivation and Contraceptive Non-use in Female Ontarian Youth. Derek Akateh* Derek Akateh Jason Were Roman Pabayo
Background: In Canada, about 15% of sexually active youths do not use birth control, with a substantially high rate of abortions and STIs among this group in the last decade. Research has explored predictors of contraceptive non-use, but there is a lack of research regarding social and environmental factors and mechanisms through which they are associated with contraception use.
Objectives: This study aimed 1) To examine the association between material deprivation and contraceptive non-use and 2) to determine whether this association was mediated by healthcare access.
Methods: We conducted a cross-sectional study using data from the 2013/2014 Canadian Community Health Survey, a population-representative survey that collects health data at the Public Health Unit (PHU) level. The CCHS dataset was linked to the 2011 Ontario Marginalization Index data. The analytic sample included 1098 sexually active females (15-24 years) across 34 PHUs in Ontario. We conducted a multilevel path analysis to determine if the relationship between PHU-material deprivation and contraceptive non-use was mediated by healthcare access.
Results: Female youth living in PHUs with higher material deprivation were significantly more likely not to use contraceptives (unstandardized ß = 0.77, 95% CI: 0.08, 1.45). Higher material deprivation was also associated with reduced healthcare access (unstandardized ß= -0.06; 95% CI: -0.12, -0.01). However, healthcare access did not mediate the relationship between material deprivation and contraceptive non-use (indirect path β =0.004; 95% CI= -0.03, 0.04).
Conclusion: Findings from this study indicate that material deprivation is associated with contraceptive non-use among female youth in Ontario and that healthcare access did not mediate the relationship. The findings suggest that addressing structural deprivation by way of lowering area-level material deprivation has the potential to impact both youth access to services and improve contraceptive use.
